Cardiac tests and procedures
Clive Handler, Gerry Coghlan, Nick Brown in Management of Cardiac Problems in Primary Care, 2018
Coronary artery bypass surgery is generally advised in patients who are unsuitable for coronary angioplasty, which is equally effective in relieving angina. Repeat revascularisation is more likely to be required in patients who have had angioplasty, because of the risks of restenosis, which are lower with the use of stents and particularly coated stents. Coronary artery surgery is preferred to angioplasty in patients with severe triple-vessel coronary artery disease and left ventricular impairment, because it confers the added advantage of improving prognosis as well as symptoms. In patients for whom no prognostic benefit is expected and in whom coronary artery surgery is considered too high a risk or is refused, coronary angioplasty is considered. All patients with coronary artery disease should have cardiovascular risk factor evaluation and treatment.
Evaluations of cardiovascular diseases with hybrid PET-CT imaging
Yi-Hwa Liu, Albert J. Sinusas in Hybrid Imaging in Cardiovascular Medicine, 2017
Figure 15.5 shows an example of a PET-CT study after coronary artery bypass surgery. A 60-year-old man was referred for evaluation of coronary artery bypass grafts due to typical chest pain one year after coronary artery bypass grafting. CTA showed that the graft from the aorta to the LAD, the diagonal branch, and the RCA were open. However, evaluation of the calcified native coronary arteries was challenging and there was a suspicion of occlusion of the distal RCA. Myocardial perfusion was evaluated with PET and 15O-water during adenosine stress. Fusion images of 3-D coronary anatomy and a map of myocardial perfusion show severely reduced (1–1.5 mL/g/min) perfusion in the area subtended by the RCA, confirming RCA occlusion (Figure 15.5a). The perfusion was normal, >2.3 mL/g/min, in the areas subtended by the LAD and LCX (Figure 15.5b). Due to severe symptoms despite optimal medication, the patient was referred for invasive coronary angiography.
Perioperative and Postoperative Deaths
Julian L Burton, Guy Rutty in The Hospital Autopsy, 2010
Most patients who die during or after cardiac surgery die from cardiac disease (Lee and Gallagher, 1998). The incidence of postoperative complications in patients undergoing coronary artery bypass grafting is 94 per cent (NCEPOD, 2008). Common autopsy findings of significance include coronary artery bypass graft thrombosis, acute myocardial infarction, small bowel infarction, congestion and fatty change in the liver and pulmonary thromboembolus. With the exception of small bowel infarction and liver changes, which are indicative of multi-organ failure and poor perfusion, other abdominal complications are rare (Hickling et al., 2007). Atrial fibrillation is common postoperatively, more so in patients who undergo valvular repair than in those who have coronary artery bypass grafting. The development of atrial fibrillation postoperatively is associated with an increased risk of stroke and death (Gomes da Silva et al., 2004).
Percutaneous coronary intervention in saphenous vein grafts after coronary artery bypass grafting: a systematic review and meta-analysis
Published in Scandinavian Cardiovascular Journal, 2021
Gabriele Ferrari, Håkan Geijer, Yang Cao, Domingos Souza, Ninos Samano
Ischemic heart disease is the leading cause of death worldwide, causing almost 9.5 million deaths in 2016 [1]. The main treatment options are percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and in some cases both. The choice of treatment depends on the clinical presentation, grade of disease, type of lesion, and patient comorbidities. Guidelines [2–4] recommend CABG in cases of multivessel disease and/or diabetes mellitus, to improve survival and reduce the risk of major adverse cardiac events (MACE) [5–9], defined as death, myocardial infarction (MI), and/or target vessel revascularization (TVR). Graft patency after CABG is a major determinant of clinical prognosis and long-term survival [10,11]. The grafts used, especially vein grafts, are subject to remodelling, progressive intimal hyperplasia, and atherosclerosis that may lead to graft stenosis or occlusion [12,13]. Saphenous vein grafts (SVGs) in CABG have high rates of thrombosis, intimal hyperplasia, and early atherosclerosis leading to graft failure between 12–20% at one year [14,15] and 50–60% at 10 years [16–19]. Despite this, the SVG is still used in over 80% of CABG cases worldwide [20].
Nanotechnological approach to delivering nutraceuticals as promising drug candidates for the treatment of atherosclerosis
Published in Drug Delivery, 2021
Sindhu C. Pillai, Ankita Borah, Eden Mariam Jacob, D. Sakthi Kumar
Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is performed by opening narrowed coronary arteries to place a stent thus improving the blood flow to the heart and mitigating chest pain. Coronary artery bypass grafting (CABG) involves the grafting of a new artery to bypass the narrowed coronary arteries while boosting blood flow and preventing heart attacks. In the list of surgical methods, carotid endarterectomy is a common surgical process that involves the correction of the internal carotid artery by removing plaque build-up eventually restoring the blood flow to the brain. Surgical procedures of the blood vessel-blockade have achieved clinical success for many years, yet are also associated with numerous complications such as restenosis, in-stent restenosis, and late-stage clotting to name a few (Giannini et al., 2018).
Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery
Published in Disability and Rehabilitation, 2019
Isadora Salvador Rocco, Marcela Viceconte, Hayanne Osiro Pauletti, Bruna Caroline Matos-Garcia, Natasha Oliveira Marcondi, Caroline Bublitz, Douglas William Bolzan, Rita Simone Lopes Moreira, Michel Silva Reis, Nelson Américo Hossne, Walter José Gomes, Ross Arena, Solange Guizilini
Short-term clinical outcomes were obtained during the inpatient period after off-pump coronary artery bypass grafting in early post-operative. Pulmonary complications (i.e., pneumonia, prolonged mechanical ventilation or atelectasis), and occurrence of a renal acute failure, low cardiac output syndrome, bleeding, and new arrhythmias (i.e., atrial fibrillation, ventricular tachycardia, or bradycardia) were recorded. Chest X-rays, taken pre-operatively and on the first days after surgery, were evaluated by a radiologist who was blind to the patients’ condition. Prolonged mechanical ventilation was considered over 12 h after intensive care unit admission. Atelectasis was acknowledged when a clear radiologic shadow exceeded 15 mm in width with linear atelectasis being disregarded in this study. Time until intensive care unit discharge and post-operative hospital days were recorded.
Related Knowledge Centers
- Angina
- Coronary Artery Disease
- Great Saphenous Vein
- Stenosis
- Ischemia
- Cardiopulmonary Bypass
- Surgical Anastomosis
- Left Anterior Descending Artery
- Anatomy of The Human Heart
- Radial Artery